Decision making at end of life among Japanese American families

This exploratory study describes decision making at end of life among Japanese American families. Using qualitative methods including a one-time, semistructured interview, 16 Japanese American family participants described their experiences with the death of 22 family members. A grounded theory analysis led to the development of a model of a process that reflected the influence of age-cohort generational differences and health care providers' involvement. The model also included four dimensions of family understanding. The four dimensions were awareness of the seriousness of the family members' condition, decision making about life-sustaining treatment, readiness for impending death, and experience of the dying process. Each dimension reflected a continuum from low to high understanding. The results suggest that nurses and other health care providers can impact the level of understanding within each of the dimensions in culturally sensitive ways and contribute to improving the experience with end-of-life decision making for Japanese Americans.